P - 76285• REQIl.EST FOR ELECTRICAL INSPECTION
1��1- �� - 515 � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
' , (651) 642-0800 TTY/MRS 1-800-6273529 www.elech-icity.state.mn.us
Descrii� -using the back of the white copy'rf necessary - the work covered by this requesh
Er�:EI_ EP�ERGi' SA1r'EF;'� �WiTt;H
GENERAL FEES Outdoor Lighting Standard @$1
SERViCES I POWER SUPPLIES Traffic Rinnal StanAarri (nl �F
I CIRCUITS, CtRCUITS OF LESS THAN 50 VOLTS
FEES
5 per Fixture
BOOm l(� $4(
I I� � IN il �l ll �{ ��I � III II III �
�I �III II
1797515�'
Transfortners u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns / Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
NG Circufts and Twro Inspection Trips Each Dwelling Unft @$80
Additional Ins ction Tri $20
Investigative Fee
Reins ection Fee @ $20
TOTALFEE
(minimum total fee is $20) �_ ��?
n��su�a Foa wsaECTOa use aw.v
I hereby certity fhat I inspected the electrical instaVaation described herein on ttie dates stated:
RWGH IN pp�
FPIAL WSPECTION • - pp�
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O��im IAB.M'OONED OAIE
DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
REC� JUN 14 2001
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I1°'O' Rough-in Inspection Required9 ❑ Yes � No Inspection Other Than Rough-In: �Ready Now � Will Call
tT ��. �. i��1 � You must call the inspector when readyl Date Ready:
i c.er�ty that I am the �] LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
JOb sile str�eet Address �m,
;81� h!E CHAi�li�lEL fil� Ff,TDLEi' I�h! 5�,4��
OwneUOCCUpent Name Please Provide Two (2) Phone Numbers
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�� ��Y Electrical Utllity Address
�CEL ENEF:G'�
CoM�AetVr / Company Name Contrector License Number Master Electrician or P
!-IUiAIT ELECT�;IC �G�iFi�F:ATSC�hI L�1 �J4,,.38J ucenseNumber
Nl�ilin� Address (Contractor, Company or Owner Perfortning Installallon)
;�.i��i IE`FiFiIT1JF�1f�L. Fi�JAD9 SPIhlT F'fiiULq (fltd 55j.1�
Autharked Signalure (Contractor or Owner Perfortning Instslladon) Please Provide Two (2) Phone Numbers I
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INSTRUCTION$ ON CK OF YELLOW COPV BOARD OF ELECTRICITV COPV